TN 14 (06-11)
DI 34001.026 Endocrine Disorders - Adult
9.00
Endocrine
Disorders
(Effective Date: 06/07/11)
A. What is an endocrine disorder? An endocrine disorder is a medical condition that causes a hormonal imbalance. When
an endocrine gland functions abnormally, producing either too much of a specific hormone
(hyperfunction) or too little (hypofunction), the hormonal imbalance can cause various
complications in the body. The major glands of the endocrine system are the pituitary,
thyroid, parathyroid, adrenal, and pancreas.
B. How do we evaluate the effects of endocrine disorders? We evaluate impairments that result from endocrine disorders under the listings for
other body systems. For example:
1. Pituitary gland disorders can disrupt hormone production and normal functioning in other endocrine glands and
in many body systems. The effects of pituitary gland disorders vary depending on which
hormones are involved. For example, when pituitary hypofunction affects water and
electrolyte balance in the kidney and leads to diabetes insipidus, we evaluate the
effects of recurrent dehydration under 6.00.
2. Thyroid gland disorders affect the sympathetic nervous system and normal metabolism. We evaluate thyroid-related
changes in blood pressure and heart rate that cause arrhythmias or other cardiac dysfunction
under 4.00; thyroid-related weight loss under 5.00; hypertensive cerebrovascular accidents
(strokes) under 11.00; and cognitive limitations, mood disorders, and anxiety under
12.00.
3. Parathyroid gland disorders affect calcium levels in bone, blood, nerves, muscle, and other body tissues. We
evaluate parathyroid-related osteoporosis and fractures under 1.00; abnormally elevated
calcium levels in the blood (hypercalcemia) that lead to cataracts under 2.00; kidney
failure under 6.00; and recurrent abnormally low blood calcium levels (hypocalcemia)
that lead to increased excitability of nerves and muscles, such as tetany and muscle
spasms, under 11.00.
4. Adrenal gland disorders affect bone calcium levels, blood pressure, metabolism, and mental status. We evaluate
adrenal-related osteoporosis with fractures that compromises the ability to walk or
to use the upper extremities under 1.00; adrenal-related hypertension that worsens
heart failure or causes recurrent arrhythmias under 4.00; adrenal-related weight loss
under 5.00; and mood disorders under 12.00.
5. Diabetes mellitus and other pancreatic gland disorders disrupt the production of several hormones, including insulin, that regulate metabolism
and digestion. Insulin is essential to the absorption of glucose from the bloodstream
into body cells for conversion into cellular energy. The most common pancreatic gland
disorder is diabetes mellitus (DM). There are two major types of DM: type 1 and type
2. Both type 1 and type 2 DM are chronic disorders that can have serious disabling
complications that meet the duration requirement. Type 1 DM--previously known as “juvenile diabetes” or “insulin-dependent diabetes mellitus” (IDDM)—is an absolute deficiency of insulin production that commonly begins in childhood
and continues throughout adulthood. Treatment of type 1 DM always requires lifelong
daily insulin. With type 2 DM--previously known as “adult-onset diabetes mellitus” or “non-insulin-dependent diabetes mellitus” (NIDDM)--the body’s cells resist the effects of insulin, impairing glucose absorption
and metabolism. Treatment of type 2 DM generally requires lifestyle changes, such
as increased exercise and dietary modification, and sometimes insulin in addition
to other medications. While both type 1 and type 2 DM are usually controlled, some
persons do not achieve good control for a variety of reasons including, but not limited
to, hypoglycemia unawareness, other disorders that can affect blood glucose levels,
inability to manage DM due to a mental disorder, or inadequate treatment.
a. Hyperglycemia. Both types of DM cause hyperglycemia, which is an abnormally high level of blood
glucose that may produce acute and long-term complications. Acute complications of
hyperglycemia include diabetic ketoacidosis. Long-term complications of chronic hyperglycemia
include many conditions affecting various body systems.
(i) Diabetic ketoacidosis (DKA). DKA is an acute, potentially life-threatening complication of DM in which the chemical
balance of the body becomes dangerously hyperglycemic and acidic. It results from
a severe insulin deficiency, which can occur due to missed or inadequate daily insulin
therapy or in association with an acute illness. It usually requires hospital treatment
to correct the acute complications of dehydration, electrolyte imbalance, and insulin
deficiency. You may have serious complications resulting from your treatment, which
we evaluate under the affected body system. For example, we evaluate cardiac arrhythmias
under 4.00, intestinal necrosis under 5.00, and cerebral edema and seizures under
11.00 . Recurrent episodes of DKA may result from mood or eating disorders, which
we evaluate under 12.00.
(ii) Chronic hyperglycemia. Chronic hyperglycemia, which is longstanding abnormally high levels of blood glucose,
leads to long-term diabetic complications by disrupting nerve and blood vessel functioning.
This disruption can have many different effects in other body systems. For example,
we evaluate diabetic peripheral neurovascular disease that leads to gangrene and subsequent
amputation of an extremity under 1.00; diabetic retinopathy under 2.00; coronary artery
disease and peripheral vascular disease under 4.00; diabetic gastroparesis that results
in abnormal gastrointestinal motility under 5.00; diabetic nephropathy under 6.00;
poorly healing bacterial and fungal skin infections under 8.00; diabetic peripheral
and sensory neuropathies under 11.00; and cognitive impairments, depression, and anxiety
under 12.00.
b. Hypoglycemia. Persons with DM may experience episodes of hypoglycemia, which is an abnormally low
level of blood glucose. Most adults recognize the symptoms of hypoglycemia and reverse
them by consuming substances containing glucose; however, some do not take this step
because of hypoglycemia unawareness. Severe hypoglycemia can lead to complications,
including seizures or loss of consciousness, which we evaluate under 11.00, or altered
mental status and cognitive deficits, which we evaluate under 12.00.
C. How do we evaluate endocrine disorders that do not have effects that meet or
medically equal the criteria of any listing in other body
systems? If your impairment(s) does not meet or medically equal a listing in another body
system, you may or may not have the residual functional capacity to engage in substantial
gainful activity. In this situation, we proceed to the fourth and, if necessary, the
fifth steps of the sequential evaluation process in §§404.1520 and 416.920. When we
decide whether you continue to be disabled, we use the rules in §§404.1594, 416.994,
and 416.994a.